User:Caramc456/Nurse practitioner

A nurse practitioner (NP) is an advanced practice registered nurse '''REMOVE: and a type of mid-level practitioner ADD: who has additional education and clinical experience beyond that of a registered nurse.  NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, ADD: and''' formulate and prescribe treatment plans. NP training covers basic disease prevention, coordination of care, health promotion, ADD: and counseling '''REMOVE: but does not provide the depth of expertise needed to recognize more complex conditions. ADD: There are similarities among the obligations and responsibilities of all nurse practitioners, however they generally vary by specialty. Specialty areas include family health, oncology, and women's health.'''

The scope of practice for a NP is defined by legal jurisdiction ADD: under The Nurse Practice Act of each state. In some places, NPs are required to work under the supervision of a physician, and in other places they can practice independently.

ADD: Reasons cited for becoming a nurse practitioner, but are not limited to, include independent practice depending on the state, a bright job outlook, salary, and choosing a specialty.

United States
The present-day concept of advanced practice nursing as a primary care provider was created in the mid-1960s, spurred on by a national shortage of physicians. The first formal graduate certificate program for NPs was created by Henry Silver, a physician, and Loretta Ford, a nurse, in 1965 ADD: at the University of Colorado. ADD: To market the NP's skilled growth, federal funding was raised, paving the means for nurses to be selected as medical care suppliers. In 1971, The U.S. Secretary of Health, Education and Welfare, Elliot Richardson, made a formal recommendation in expanding the scope of nursing practice to be able to serve as primary care providers. ADD: NP certificates were offered in more than 500 program locations across the United States by the mid-1970s, and several master's programs had been established by the early 1980s. In 2012, discussions arose between accreditation agencies, national certifying bodies, and state boards of nursing about the possibility of making the Doctor of Nursing Practice (DNP) degree the new minimum standard of education for NP certification and licensure by 2015.

Canada
Advanced practice nursing first appeared in the 1990s in Ontario. These nurses practiced in neonatal intensive care units within tertiary care hospitals in collaboration with pediatricians and neonatologists. Although the role of these nurses initially resembled a blended version of clinical nurse specialists and NPs, today the distinction has been more formally established.

ADD: Duties
ADD: Depending on their specialty and scope of practice, nurse practitioners fulfill a wide range of tasks, but the most common ones are as follows:


 * Order and perform diagnostic tests such as lab work and x-rays.
 * Diagnose and treat various conditions such as diabetes and high blood pressure.
 * Some nurse practitioners can prescribe medications and other treatments.
 * Nurse practitioners oversee the complete treatment of their patients.
 * Patients are counseled regarding preventative care and healthy lifestyle choices.
 * Provide immunizations
 * They may also perform physical exams. 

ADD: Qualities
'''ADD: It is crucial for nurse practitioners to possess a set of characteristics in order to succeed in their field. NPs should be sympathetic and considerate of their patients' circumstances and perspective in order to respond in an appropriate manner. NPs should also be very attentive and responsive to the patient’s condition and ensure their requisites are addressed. NPs provide a variety of treatments that can impact the patient’s overall health. There are many more skills that are fundamental to prosper as a nurse practitioner.'''

Education requirements
REMOVE: Becoming a nurse practitioner requires at least 1.5 years of post-baccalaureate training. ADD: '''The first step to becoming a nurse practitioner is becoming a registered nurse. It is required to obtain a bachelor’s degree in nursing or an associate degree in nursing. After completion of their program, one must pass the National Council Licensure Examination (NCLEX). In this exam, your nursing comprehension and critical thinking skills will be tested. Once this exam is passed, you must apply for a RN license in your state. Some nurses may choose to gain experience as a nurse before continuing their education, but it is not required. One must then enroll in a graduate program, whether a Master of Science in Nursing (MSN) program or Doctor of Nursing Practice (DNP) program. For RNs without bachelor’s degrees there are RN-to-MSN or ADN-to-MSN programs. Upon completion of the graduate program, one must pass the National NP Certification Board Exam, specific to one’s specialization. After passing this exam, one must apply for NP licensure which varies from each state.''' During their studies, nurse practitioners are required to receive a minimum of 500 hours of clinical training.

Although nurse practitioners are required to be licensed as registered nurses prior to obtaining their advanced practice registered nurse certification, there are several programs that combine a nursing undergraduate degree with nurse practitioner training. Other nurse practitioner programs have 100% acceptance rates. Therefore, experience as a registered nurse is not required to become a nurse practitioner.

Training pathways
There are many types of nurse practitioner programs in the United States with the vast majority being in the specialty of a Family Nurse Practitioner (FNP). There are also Psychiatric, Adult Geriatric Acute Care, Adult Geriatric Primary Care, Pediatric, ADD: Cardiac, Women's Health, Oncology and Neonatal nurse practitioner programs. Many of these programs have their pre-clinical or didactic courses taught online with proctored examinations. Once the students start their clinical courses they have online material, but are required to perform clinical hours at an approved facility under the guidance of an NP or Physician. Each clinical course has specific requirements that vary on their program's degree/eligibility for certification. For instance FNPs are required to see patients across the lifespan whereas Adult Geriatric NPs do not see anyone below the Age of 13.

Quality of care
A review of studies comparing outcomes of care by NPs and physicians in primary care and urgent care settings were generally comparable, although the strength of the evidence was generally low, with virtually all of the studies sponsored by nursing organizations. A recent study showed nurse practitioners practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than nurse practitioners in prescription-restricted states. Nurse practitioners and physician assistants were also associated with more unnecessary imaging services than primary care physicians, which may have ramifications on care and overall costs.

One systematic review suggests "that the implementation of advanced practice nursing roles in the emergency and critical care settings improves patient outcomes in emergency and critical care settings".

Australia
In Australia, a nurse practitioner-endorsed registered nurse has an expanded scope of practice, allowing them to practice certain advanced clinical skills within their endorsed field. As a nurse practitioner, they can: complete advanced health assessments, diagnose and treat diseases, order diagnostic testing such as imaging and pathology, and prescribe medications and therapeutics. Nurse Practitioners can, unlike non-endorsed Registered Nurses, access Medicare (universal healthcare system) payments for the services they provide to patients. A Nurse Practitioner is not responsible for delegating care tasks to Registered Nurses in the same way a Registered Nurse delegates some care tasks to Enrolled Nurses, but has a senior clinician designation in the hierarchy of clinical staff.

Canada
In Canada, an NP is a registered nurse (RN) with a graduate degree in nursing. Canada recognizes them in primary care and acute care practice. NPs diagnose illnesses and medical conditions, prescribe Schedule 1 medications, order and interpret diagnostic tests, and perform procedures, within their scope of practice, and may build their own panel of patients at the same level as physicians. Primary care NPs work in places like primary care and community healthcare centers, as well as long-term care institutions. The main focus of primary care NPs includes health promotion, preventative care, diagnosis and treatment of acute and chronic diseases and conditions. Acute care NPs serve a specific population of patients. They generally work in in-patient facilities that include neonatology, nephrology, and cardiology units. There are currently three specialties for Nurse Practitioners in Canada: Family Practice, Pediatrics, and Adult Care. NPs who specialize in Family Practice work at the same level and offer the same services as Family Physicians with the exclusion of Quebec, where only Physicians are allowed to formulate a medical diagnosis.

Ireland
Ireland's publicly funded healthcare system, the Health Service Executive has the advanced nurse practitioner (ANP) grade. ANPs may prescribe medications.

United Kingdom
In the United Kingdom nurse practitioners carry out care at an advanced practice level. They commonly work in primary care (e.g. GP surgeries) or A&E departments, although they are increasingly being seen in other areas of practice.

United States
Because the profession is state-regulated, the scope of practice varies by state. Some states allow NPs to have full practice authority, however, in other states, a written collaborative or supervisory agreement with a physician is legally required for practice. Autonomous practice was introduced in the 1980s, mostly in states facing a physician shortage or that struggled to find enough healthcare providers to work in rural areas. The extent of this collaborative agreement, and the role, duties, responsibilities, nursing treatments, and pharmacologic recommendations again varies widely between states.

NPs can legally examine patients, diagnose illness, prescribe some medications, and provide treatments. In 2017, twenty-two states gave full practice authority to NPs and do not require the supervision of a physician. Thirty-eight states require NPs to have a written agreement with a physician in order to provide care. Twelve of those states require NPs to be supervised or delegated by a physician, this physician may not be on site.

Australia
In Australia, nursing registration including endorsement of a RN as a Nurse Practitioner is overseen by the Nursing and Midwifery Board of Australia (NMBA) and the Australian Health Practitioner Regulation Agency (Ahpra). Registered Nurses working in rural and isolated communities can apply for scheduled medicine prescriber endorsement if clinically necessary and trained, and instead become a prescribing Registered Nurse rather than a Nurse Practitioner to better meet the need of less-resourced communities. Nurse Practitioners are professionally represented by the Australian College of Nurse Practitioners, as well as the Australian College of Nursing. Endorsement as a Nurse Practitioner in either Australia or New Zealand is recognised by both countries as part of the Trans-Tasman Mutual Recognition Scheme.

For a RN to apply to the NMBA for Nurse Practitioner endorsement, they must be able to demonstrate they have completed at least 5000 hours (three years, full-time equivalent) at an "advanced nursing practice" level. Advanced nursing practice is loosely defined, and not a specific role, but rather a recognised process of higher-level clinical practice within a nurse's existing scope of practice. The RN must also complete an approved Nurse Practitioner postgraduate master's degree, or demonstrate they have gained qualifications to an equivalent level in advanced health assessment, pharmacology, therapeutics, diagnostics, and research. Nurses applying through the latter pathway must also demonstrate the equivalent training is clinically relevant to the field for which they wish to apply for Nurse Practitioner endorsement in.

Canada
In Canada, the educational standard is a graduate degree in nursing. The Canadian Nursing Association (CNA) notes that advanced practice nurses must have a combination of a graduate level education and the clinical experience that prepare them to practice at an advanced level. Their education alone does not give them the ability to practice at an advanced level. Two national frameworks have been developed in order to provide further guidance for the development of educational courses and requirements, research concepts, and government position statements regarding advanced practice nursing: the CNA's Advanced Nursing Practice: A National Framework and the Canadian Nurse Practitioner Core Competency Framework. All educational programs for NPs must achieve formal approval by provincial and territorial regulating nurse agencies due to the fact that the NP is considered a legislated role in Canada. As such, it is common to see differences among approved educational programs between territories and provinces. Specifically, inconsistencies can be found in core graduate courses, clinical experiences, and length of programs. Canada does not have a national curriculum or consistent standards regarding advanced practice nurses. All advanced practice nurses must meet individual requirements set by their provincial or territorial regulatory nursing body.

Israel
As of November 2013, NPs were recognized legally in Israel.

United States
The path to becoming an NP in the U.S. begins by earning an undergraduate degree in nursing and requires licensure and experience as an RN. One must then complete graduate or doctoral studies with additional medical training before taking national board certification testing in their specialty field.

ADD: Job settings
'''ADD: Nurse practitioners are currently employed in a wide variety of practice settings. These settings include the ambulatory, inpatient, or emergency room of hospitals, health clinics, and office practices whether private or nurse-run. In addition, they serve in schools and college campuses delivering care as well as nursing homes and assisted living facilities. NPs can work alone or under the supervision of a physician in a wide variety of specializations.'''

Salary
The salary of an NP generally depends on the area of specialization, location, years of experience, and level of education. In 2015, the American Association of Nurse Practitioners (AANP) conducted its fourth annual NP salary survey. The results revealed the salary range to be between $98,760 to $108,643 reported income among full-time NPs. According to the U.S. Bureau of Labor Statistics, NPs in the top 10% earned an average salary of $135,800. The median salary was $98,190. According to a report published by Merritt Hawkins, starting salaries for NPs increased in dramatic fashion between 2015 and 2016. The highest average starting salary reached $197,000 in 2016. The primary factor in the dramatic increase in starting salaries is skyrocketing demand for NPs, recognizing them as the 5th most highly sought after advanced health professional in 2016.

ADD: Importance during the Covid-19 pandemic
'''ADD: During the COVID-19 pandemic, nurse practitioners played an integral role by servicing the need for clinicians during the outbreaks of the crisis. NPs provided quality care to patients testing positive for COVID-19. Temporarily, the pandemic expanded the scope of practice for nurse practitioners as a result of legislative policy adjustments. Under the Trump Administration, many requirements for nurse practitioners were waived, permitting NPs to utilize their abilities to the fullest extent in some cases.'''